Health Direct » 2005 » April

UK not ready for biometric ID cards

Dr Search- Principal Consultant at the Search Clinic — Sat, 30 Apr 2005 08:38:00 +0000

The technology needs to be looked at more closely, warn analysts. Although the government seems determined to push forward with national ID cards, industry experts warned that major technological issues could derail the scheme.
Mark Blowers, senior research director at independent UK technology analyst Butler Group, believes that the biometric technology behind the proposed ID card scheme must be looked at more closely in order for the project to have a chance of succeeding.
“Although the Home Secretary’s plans for the introduction of a national ID card are well intentioned, Butler Group believes the use of biometrics on ID cards requires more in-depth study,” he said.
“There are still a number of issues which have the potential to derail Labour’s plans to tackle crime and terrorism.”
While agreeing that the use of biometrics will make the cards inherently more secure, Blowers warned that it is the practicalities of its use that cause concern.
There are four clear areas that Butler Group believes must be addressed:
Cost: The addition of biometrics greatly increases the cost, not just of card production and the need for specialist readers, but for registration.
Technology: Biometrics is still an emerging technology with worries about rejection rates. Some biometric technologies have yet to achieve acceptable read accuracy.
Privacy: The planned holding of the information on a central database gives rise to concerns about who will be allowed access.
Scalability: The use of biometrics on this scale has never been attempted before.

http://www.vnunet.com/news/1159628

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NHS debts soar to over Billion Pounds

Dr Search- Principal Consultant at the Search Clinic — Sat, 30 Apr 2005 08:35:00 +0000

Hospitals and primary care trusts have run up an estimated total debt of £1 billion, raising more questions about how Labour is spending the billions it has taken in tax for the National Health Service.
A Telegraph investigation has revealed the extraordinary measures that trusts are using to fend off financial disaster. Wards are being closed, frontline medical staff cut, operations cancelled – and piles of unpaid bills are mounting up.
Evidence obtained under the Freedom of Information Act or from NHS staff contradicts Labour’s manifesto claim that “the NHS is being restored to good health”.
The investigation raises the question of where the extra funding that was taken from taxpayers on the promise of an improved NHS has gone. Total spending on the NHS this year alone is expected to hit £69 billion.
Among the documents obtained by this newspaper is a letter from an independent auditor, which says that health services in Surrey and Sussex, did “not appear to have established sufficient arrangements by November 2004 to maintain sound financial standing in 2004/5″.
Another letter, from an anonymous NHS employee, said that an emergency medical service in Runcorn and Widnes recently had its telephone line disconnected after bills went unpaid. At the same service, it is alleged, money is so scarce that even a request for a shredder was refused. Instead, staff were told to “tear up small” all confidential patient records.
Yesterday a spokesman for John Reid, the Health Secretary, said: “Investment has doubled since 1997 and will triple by 2008. It is the job of NHS managers to work within their budgets, and that’s what they are doing.”
However, Chris Grayling, the Conservative health spokesman, said: “The reality is that much of the NHS is now bankrupt and all round the country hard decisions are being taken about cutting back services.
“Over the past seven years the Government has doubled the amount of money we spend on health. But much of it seems to have been dropped into a black hole. This is the real story of what is happening in too much of the NHS.”
20 April 2005: Blair refuses to back down as he is accused of lying over NHS
10 April 2005: Revealed: the memos that prove No 10 puts NHS targets before the safety of patients.

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/04/24/nhs24.xml&sSheet;=/portal/2005/04/24/ixportal.html

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Suspended IT CIO leader resigns

Dr Search- Principal Consultant at the Search Clinic — Sat, 30 Apr 2005 08:28:00 +0000

The going just got tougher- the resignation of a high-flyer helping to implement the e-health initiative does not bode well for the project.
A good maxim for dictators is: don’t invade Russia. The equivalent rule for NHS computing is: don’t start with London.
All the foibles that make computerising healthcare difficult anywhere are magnified by the capital’s ancient teaching hospitals, transient population and high political profile.
Eighteen months ago, the £6bn NHS national programme for IT went against that wisdom when it picked London to be one of the first of five regions across England to introduce new systems. It may now be regretting its decision. Far from being a pioneer, the programme in London is lagging amid technical and financial worries and the resignation of one of its top officials following his suspension from duty.
Connecting for Health, the agency responsible for the national programme, said on Tuesday that London’s chief information officer, David Kwo, had resigned. Kwo had been suspended from duty since April 14 “to enable proper investigations into a serious allegation”. A spokesperson for the agency said that Kwo’s resignation letter did not mention his suspension. No further details were available.
Kwo was one of the five key individuals implementing the world’s largest civil IT programme. He was well qualified for the role. An American former management consultant who has lived in the UK for 20 years, Kwo was the first NHS IT director to sit on a hospital board, at Chelsea and Westminster trust. At the flagship hospital, he was responsible for installing an electronic patient-record system based on software from a US- based specialist supplier, Phamis (now IDX). Although the mainframe-based system had a high upfront cost, it was seen as a rare success story for London.
In December 2002, Kwo was appointed chief information officer for the whole of London, one of five “clusters” of health authorities created to procure systems under the national programme. The idea was to create contracts large enough to attract “world class” IT suppliers, but not to become reliant on any single firm.
In December 2003, the London cluster signed a £966m contract with BT to provide systems across the capital, based on IDX software. IDX’s share of the contract is estimated to be worth £200m.
The same software was later chosen for a region covering the whole of southern England, from Cornwall to Kent. (The other three regions, covering England north of the Severn, picked software from iSoft, a UK- based firm which is a close partner of Microsoft.)
By last winter, the new software for London and southern England was running late. A specialist online news service, E-Health Insider, reported that it had seen documents showing that the new system’s basic clinical functions would not be ready until June 2006 at the earliest, nine months behind schedule.
In February, the NHS signed a “shared governance arrangement” with BT and Fujitsu, the prime contractor for southern England, to get the programme back on track.
London’s woes are not fatal to the whole programme. It was designed from the outset to cope with local setbacks. Contracts provide for successful suppliers in one region to “step in” to replace contractors that are failing elsewhere. Connecting for Health’s chief executive, Richard Granger, hinted last month that he may use these powers.
However, delays provide ammunition to critics who say the whole programme is flawed. A Conservative- leaning thinktank, Aediles, has called for NHS contracts to be renegotiated and put in the public domain. The programme is also under scrutiny from bodies as diverse as the BMA, the National Audit Office and the Worshipful Company of Information Technologists, which is worried about the damage that failure would do to the IT profession.
Concern is also growing in the IT industry. At least two suppliers, Indian-based services firm TATA Consultancy Services, a partner of Fujitsu, and Accenture, prime contractor in the north of England, have reported that delays to the programme are hitting their balance sheets. One of the programme’s innovations was that suppliers would not be paid until systems are in place and working. The industry is now putting pressure on the government to reconsider those terms.
Senior officials were unable to comment this week because of the election campaign purdah surrounding civil servants. The programme has posted a “12-week forecast” on its website showing that new systems, such as a web-browser for electronic booking, are still being installed in London. But a new brochure suggests that the NHS is in for a long slog. “Systems and services will be gradually phased in across England over the next six years”. It also notes that: “As with all major projects there will be difficulties … along the way.”
Kwo’s resignation is without doubt a “difficulty”. Colleagues point out that, with so much money and credibility at stake, many vested interests have a motive for sabotage and backstabbing. But anyone familiar with the NHS in London would have known that all along.

http://www.guardian.co.uk/online/story/0,3605,1471391,00.html

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GP row- bliar makes more promises

Dr Search- Principal Consultant at the Search Clinic — Fri, 29 Apr 2005 10:52:00 +0000

Tony Blair is facing claims that GPs are not allowing advance appointments because of government targets. The Labour leader said he was “astonished” when the complaint was raised on the BBC’s Question Time.
Doctors’ leaders say the GP target to see patients within 48 hours is crude. Labour says the target ensures speedy access to GPs for most people.
After days dominated by rows on Iraq, the election campaign is shifting focus to other issues on Friday.
Mr Blair is attacking the Conservatives’ economic plan with Labour’s latest poster launch while Tory leader Michael Howard is highlighting his plans for immigration.
Liberal Democrat leader Charles Kennedy has explained why he thinks his party is offering the most generous deal for elderly people.
Target culture?
All three main party leaders appeared separately on a BBC Question Time Special on Thursday to take audience questions.
Mr Blair heard concerns about the effect of the government’s target of ensuring people could get a GP appointment within 48 hours.
One audience member, Diana Church, said: “You can’t make the appointment in a week because you are only allowed to make it 48 hours beforehand.
Question Time summary
“You have to sit on the phone for three hours in the morning trying to get an appointment because you are not allowed to ask for the appointment before that because by making it 48 hours beforehand they are meeting the government’s target.”
When others in the audience concurred, Mr Blair said: “That is news to me.”
He admitted this interpretation of the targets was “absurd” and said he would look into it.
Conservative shadow health secretary Andrew Lansley, said: “Mr Blair is out of touch with what is going on in the NHS. “It is his government that set the targets which distorts the way GPs want to run their practice and constricts patient choice.”
Lib Dem spokesman Paul Burstow said targets meant patients were let down.
“It’s about time we scrapped the political targets, had good clinical standards and trusted doctors and nurses to be able to use their common sense and clinical judgement so we always ensure the sickest patients get treated the quickest,” he said.
GPs warned
On Friday, Dr Hamish Meldrum, the chairman of the British Medical Association’s GP committee, said the targets skewed priorities. He said: “We’ve always felt that this has been a crude target which has distorted priorities…. It has rather taken away from GPs what they always used to do which was to prioritise appointments on the basis of need.”
The NHS chief executive has told surgeries to stop restricting appointments. Health Secretary John Reid said it affected only 2% of surgeries, but could still involve several patients.
Mr Reid said: “The situation is transformed and far better than it was seven years ago when the vast majority of people could not even see a doctor in eight to 10 days.”
He suggested the GP target could be altered to give more flexibility.
There were now more GPs in practice and in training than ever before, but more were needed, added Mr Reid.
On Friday, Mr Blair again argued the economy was the central issue of the election battle.
He urged voters not to put economic stability and investment in public services at risk by letting the Tories in.
Labour wants to steer attention away from Iraq but Rose Gentle, whose son Gordon was a fusilier killed in Iraq, has announced she plans to take legal action over his death.
The government published the attorney general’s full legal advice on the Iraq war on Thursday after part of it was leaked to the media.
Tony Blair said it was a “damp squib” which showed the war was lawful – a comment the Lib Dems said insulted soldiers’ families.
The Conservatives say the document reinforces their claims that Mr Blair lied about the war.
But Mr Howard also told Question Time he would have invaded Iraq even if he had known Saddam Hussein had no weapons of mass destruction.
Speaking in Cardiff on Friday, Mr Howard renewed his calls for migration quotas and said his plans to change the asylum system would make it “more humane”.
The Lib Dems have focused on their plans for elderly people, including raising the basic state pension for over-75s by £100 a month and free personal care.

http://news.bbc.co.uk/1/hi/uk_politics/vote_2005/frontpage/4495865.stm

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NHS fertility system in chaos

Dr Search- Principal Consultant at the Search Clinic — Thu, 28 Apr 2005 08:16:00 +0000

Plans to reform fertility treatment available on the NHS have resulted in a chaotic system with vast differences in the level of treatment on offer.
Health Secretary John Reid set a deadline of 1 April this year for all eligible women to get one free cycle of IVF treatment. But analysis of the system by a Parliamentary group and fertility watchdogs found:
# Women in some areas have to wait up to two years for treatment.
# Some areas which previously offered several cycles of IVF are reducing their provision to one.
# Wide discrepancies between the criteria to qualify for treatment.
The shake-up was seen as a step towards implementing guidelines issued by the National Institute for Clinical Excellence recommending that women should eventually receive three free cycles to give them the best chance of conceiving.
In London some areas were providing up to three free treatments while in other places women were not entitled to any.
Now most Primary Care Trusts, which pay for treatment for patients, are promising to provide one free treatment while others are continuing to offer more.
But critics say the guidelines are in danger of becoming irrelevant because of the long waiting times in some areas.
Some women are in danger of waiting so long that they will breach the upper age limit of 39 by the time they reach the front of the queue.
There are also differences in the upper age limit for women, policies on treating those who already have children or how long they must have been trying for a child before treatment.
The All Party Parliamentary Group on Infertility (APPGI) and National Infertility Awareness Campaign found that:
# Brent used to offer two and sometimes three free cycles, but has now reduced that to one.
# Bromley offered all eligible women two cycles, but will now give women under 38 one cycle and women over 38 two.
# Harrow has a waiting time of anything up to 12 weeks while in neighbouring Barnet women can wait up to two years.
# Richmond and Twickenham provides three free cycles, but is reviewing its position.
# Ealing says women must not have had previous fertility treatment whereas City and Hackney will treat those who have had up to three previous attempts.
# Barnet treats only non-smokers.
# Islington will treat those who have been infertile for a year, while in Hounslow women must have been infertile for three years.
# Enfield will treat those in a ” longterm” relationship, while Islington stipulates a two-year relationship and Redbridge three years.
APPGI chairman Kevin Barron MP said: “We are still not achieving the equal access to infertility services on the NHS couples deserve.”

http://www.thisislondon.co.uk/news/articles/18148667?source=Evening%20Standard

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Labour to give heroin on the NHS

Dr Search- Principal Consultant at the Search Clinic — Wed, 27 Apr 2005 10:48:00 +0000

Hundreds more heroin addicts are to be given a fix on the NHS. Hundreds of heroin addicts will be able to get the drug free on the National Health Service under a Government programme.
Pilot schemes starting in June will expand the number of long-term addicts given injectable heroin if they fail to respond to other treatments such as methadone.
Ministers have been advised by drug treatment specialists that the introduction of “heroin clinics” in Switzerland and Holland during the 1990s significantly reduced drug-related crime and other social problems.
But members of communities in south London and Manchester, where the pilot schemes will be conducted, are unhappy at the prospect of up to 100 addicts visiting the centres daily to shoot up.
Around 450 heroin users currently receive the Class A drug on prescription.
The Treatment Agency, set up by the Government in 2001 to improve NHS drug treatment services, said if the pilots were successful, recommendations including wider prescribing of the drug to addicts would be extended, leading to hundreds more getting heroin on the NHS.
An agency spokesman said: “The majority of patients on substitution medication get oral methadone. What we are suggesting is that, if that is not working, we may need to look at other forms of treatment. That could be a different dose of methadone. It could be injectable methadone or some may benefit from treatment with injectable heroin.
“There may be an increase in the numbers receiving injectable heroin, but we are talking about hundreds not thousands.” As well as the 450 long-term addicts who currently get heroin on the NHS, around 3,000 receive the milder substitute methadone.
There are around 56,000 registered heroin addicts in Britain. The total number of users is thought to be at least four times that figure, according to the charity Drugscope.
If oral methadone treatments do not keep the user’s addiction in check, and curb their anti-social behaviour and tendency to steal to feed their habit, methadone injections are tried.
If they, too, fail to keep the user out of crime heroin injections are prescribed along with counselling.
In the 1970s, 20 per cent of heroin addicts who received NHS treatment were given the Class A drug. This has fallen to less than 0.5 per cent.
There are fewer than 100 doctors who hold the special Home Office licence required to prescribe heroin. Of these, there are 20 each in the South-East, London and the North-West but only a handful in other regions.
The pilot projects will be based in clinics at the Maudsley Hospital in Camberwell, south London, and at the Trafford Substance Misuse Service in Sale, Manchester.
The Treatment Agency spokesman said: “There are some concerns in the communities where the pilots will take place.
“The patients are from the areas where the pilots are taking place, and part of the pilots will involve working with the communities to alleviate concerns.”
David Davis, the shadow home secretary, said: “Conservatives believe the best way to combat hard drug addiction is residential rehabilitation.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/04/25/nheroin25.xml&sSheet;=/news/2005/04/25/ixhome.html

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Labour are not empowering Matrons

Dr Search- Principal Consultant at the Search Clinic — Tue, 26 Apr 2005 08:39:00 +0000

Staff ‘lack power’ to up cleanliness- hospital matrons still do not have real power to influence the standards of cleanliness in hospitals despite the Matron’s Charter published last year by the Department of Health, according to the Royal College of Nursing (RCN).
In a debate at last week’s clean hospitals summit organised by the Patients Association, RCN senior policy officer Mike Hayward said information the organisation was receiving revealed that many matrons did not have the financial power necessary to improve cleanliness.
‘We are being told that in many trusts…matrons still do not have the teeth to implement changes,’ he said. ‘We need to ensure matrons are given control of cleaning services and that they are allowed to take any steps which they believe are necessary to improve standards.’
The charter outlined targets which matrons should aim to deliver as part of maintaining good standards of hygiene and imposed a responsibility on trusts to enable them to do this.
In response to an audience question about whether directors responsible for infection control should have a place on trust boards, junior health minister Lord Warner said the DoH had not made this a mandatory requirement, but that the director ‘should have a clear line of accountability to the chief executive’.
Another delegate said she was concerned that arrangements under Agenda for Change for healthcare staff to receive training in infection control would not apply to private contractors’ staff.
‘Staff under Agenda for Change will be motivated to acquire infection-control training because it is part of the new pay package, but private contractors’ staff will not have the same incentive,’ she argued.
A Patients Association spokesman said it will collate all the evidence on best practice and areas of concern raised at the conference and send a report to the DoH.
‘We have issued a “100-day challenge” to the DoH to take action on a number of issues following the conference and we will be checking to see what action they have taken,’ he said.
The association said it would also ask trusts what action they had taken on infection control at the end of this period.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2244824

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50,000 Nurses left NHS in 2004

Dr Search- Principal Consultant at the Search Clinic — Mon, 25 Apr 2005 07:59:00 +0000

Recruits to nursing ‘must double’ according to the Royal College of Nurses. Thousands of UK-trained NHS nurses are quitting every year despite efforts to boost recruitment, the union has warned. Reasons for leaving included violence by patients and rigid working hours, the Royal College of Nursing said.
If the trend continues, the number of annual new recruits will need to double to 66,000 by 2014, its report says.
About 50,000 UK trained nurses have left or retired in the past year, with just over 20,000 recruits joining and another 12,000 coming in from abroad.
The RCN report, entitled UK Nursing Labour Market Commentary 2004/05, was published before the college’s annual congress in Harrogate.
The government has not only got to pay attention to bringing them in but keeping them said Dr Beverly Malone the RCN’s general secretary.
She quoted data from the NHS National Workforce Projects team which said the number of nurses retiring each year would increase from 15,000 in 2004 to 25,000 in 2014.
In addition, the RCN estimated 35,000 nurses left the profession last year for other reasons, such as starting a family, and predicted that number would increase each year over the next decade.
The college said increasing numbers of nurses were leaving the profession because of inflexible working hours, fear of violence in the workplace and dissatisfaction with changes to the pension scheme.
It said only 20,588 UK trained nurses joined the register in 2004/05, with another 12,692 nurses from overseas.
As a result, the number entering the profession annually would need to almost double from just under 33,000 in 2004 – to reach 66,000 – by 2014, the RCN said.
Dr Beverly Malone, RCN general secretary, said nurses “are coming in the front door” but “falling out the back. The government has not only got to pay attention to bringing them in but keeping them in,” she said.
The report said overseas recruitment has accounted for 45% of all NHS intake over the past four years.
But Dr Malone said the UK’s overseas nurses could easily be snapped up by another country with staff shortages in the future.
“We have to pay more attention to students and issues such as bursaries,” she said. She also called for more flexible working hours, better childcare and guaranteed pension arrangements.
A Labour Party spokesman defended the government’s record saying there are 77,000 more working nurses now than there were in 1997. “There are also more nurses in training than ever before,” he said.
But Shadow Health Secretary Andrew Lansley said nurses must be given more responsibility for the NHS to retain them.
Paul Burstow, Liberal Democrat health spokesman, said: “We will sustain extra investment in the NHS and work to improve morale by a smooth implementation of the new pay deal for nurses.”

http://news.bbc.co.uk/1/hi/health/4472351.stm

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Reid bins anti-closure petition

Dr Search- Principal Consultant at the Search Clinic — Fri, 22 Apr 2005 14:46:00 +0000

More than 2,000 signatures were gathered from the hospital campaigners trying who are trying to save a children’s ward say they are “sickened” after a petition they handed to the health secretary was found dumped in a skip.
More than 2,000 signatures were gathered, opposing plans to downgrade Battledown ward at Cheltenham General.
The Department of Health has not apologised but said it had made checks on the letters and petition and found they had been “logged and actioned”.
It says it has made changes to the way hard copies of letters are dealt with.
“This is absolutely sickening, I feel very, very angry” said campaigner Julie Coles.
The letters were handed in person to John Reid by Ms Coles during a visit to Gloucester on 15 March.
They turned up 50 miles away in Oxford in a recycling bin along with personal letters to the Prime Minister.
“All correspondence to health ministers is scanned into a confidential database so that it can be circulated securely,” said a spokesperson for the Department of Health.
“The petition and other correspondence were then put in the Department’s internal post system and should not have left Richmond House (the DoH HQ).
“We have instigated immediate changes to the way hard copies of correspondence are dealt with in order to avoid this happening again, and will be carrying out a full internal investigation.
But that is not enough to satisfy some of the campaigners.
“I really can’t see that they can have done everything that they said they had done within 24 hours,” said Julie Coles.

http://news.bbc.co.uk/1/hi/england/gloucestershire/4466197.stm

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Leading NHS IT specialist suspended

Dr Search- Principal Consultant at the Search Clinic — Fri, 22 Apr 2005 09:12:00 +0000

A top official has been suspended at a critical stage in the £6bn NHS programme to implement electronic health records and hospital appointment booking systems.
David Kwo, regional implementation director for the NHS Connecting for Health London cluster, was suspended from duty last Thursday to allow an investigation into allegations that have been received, Connecting for Health said in a statement.
“He will remain suspended until such time as the investigation has been completed. The suspension is not a judgement but a precautionary measure to ensure that an appropriate and fair investigation can take place.
“In the interim, Martyn Forrest, regional implementation director for the North East cluster, will be acting regional implementation director for London.”
Connecting for Health refused to comment further on the nature of the allegations or how long the investigation was expected to take.
Health IT staff in London and Capital Care Alliance, the BT-led consortium for the London implementation of the programme, are likely to be concerned about how Forrest can take on the additional workload in an already demanding roll-out programme.
In March last year, at a national programme briefing to IT executives, Kwo said he wanted chief executive officers and clinicians in the NHS to promote the programme with “fire in their bellies”.
Otherwise, he said, they would not be able to “hold the line when early resistance, which is natural in the beginning, emerges”.

http://www.computerweekly.com/articles/article.asp?liArticleID=138011&liArticleTypeID;=1&liCategoryID=2&liChannelID;=105&liFlavourID;=1&sSearch;=&nPage;=1

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Reid lies about binned petition and letters

Dr Search- Principal Consultant at the Search Clinic — Thu, 21 Apr 2005 08:16:00 +0000

A petition to save a children’s ward found in skip- the protest about partial closure of paediatric unit discovered in recycling skip along with confidential letters to Blair and Reid.
A bundle of personal letters to Tony Blair and John Reid giving confidential information about people’s bad experiences of the NHS has been found dumped in a paper recycling skip in Oxford and passed to the Guardian.
It includes a petition with the signatures of 2,007 citizens of Cheltenham protesting about the partial closure of Battledown children’s ward, in the local NHS hospital.
The petition was handed personally to Mr Reid during a visit to the area on March 15 and marks on the file suggest that he passed it within 24 hours to civil servants in the southern division of his ministerial briefing unit in London.
Its dumping may be particularly embarrassing to the government, because the campaigners are putting up an independent candidate at the general election to fight to save Battledown ward.
Bob Hodges, 29, a junior doctor at Cheltenham general hospital, is hoping to repeat the success at the last election of Richard Taylor, the independent MP for Wyre Forest who seized the seat on a campaign to stop the closure of departments of Kidderminster hospital.
Dr Hodges said last night: “I am shocked that the petition has been dumped in this way, but not particularly surprised. We feel ignored by everyone.
“John Reid also received a letter from 35 consultants at Cheltenham hospital presenting the clinical case against Battledown ward being downgraded into a small unit for paediatric day cases. It would be interesting to know which skip that has been thrown in.”
Julie Cole, the parent who organised the petition, said she presented 2,007 signatures to Mr Reid and another 23,000 to the Cotswold and Vale primary care trust.
“I feel absolutely gutted,” she said. “I started the campaign in January last year. “John Reid said he would look into the matter. I didn’t realise he thought we were so low that he couldn’t even be bothered to look at things.”
The bundle was sent anonymously to the Guardian with a covering note saying: “Found in paper recycling skip in Oxford.”
It included 30 letters from aggrieved patients and members of their families sent in the past two months. The most recent was dated April 7: no more than a week before it was discarded.
By contacting several of the senders in a wide area of southern England, the Guardian established that the letters were genuine.
Replies were written by civil servants before the letters were insecurely dumped. There was no way of confirming whether or why this was done in Oxford.
Several complainers gave written permission to the Guardian to disclose the per sonal information in their letters.
They included a complaint to Tony Blair from a former nurse whose gynaecological operation was cancelled an hour before she was due to go into Worcester royal hospital on February 1.
Ann Hodgson of Droitwich said the hospital told her it had cancelled 20 patients that morning and that she was the only one to complain. She told the Guardian: “I was horrified at the apparent lack of security in dealing with the correspondence.”
A spokeswoman for the Dep artment of Health said: “All correspondence to health ministers is scanned on to a confidential database so that it can be circulated securely to appropriate members of staff for action. “Checks show that these letters and the petition about Battledown children’s ward have been logged and actioned. The petition and other correspondence were then put in the department’s internal post system and should not have left Richmond House [the London headquarters]. We have instigated immediate changes to the way hard copies of correspondence are dealt with in order to avoid this happening again, and will be carrying out a full internal investigation.”
Battledown ward is a modern paediatric unit with 26 inpatient beds at Cheltenham general hospital, part of Gloucestershire hospitals NHS foundation trust.
Campaigners are fighting plans to downgrade it to a unit which would be unable to keep patients after 10pm or undertake many types of treatment.

http://www.guardian.co.uk/uk_news/story/0,,1463554,00.html

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Only 13% Docs support bliar

Dr Search- Principal Consultant at the Search Clinic — Wed, 20 Apr 2005 15:19:00 +0000

Labour’s lost our vote- most doctors backed Blair in 1997. But now many believe his NHS policies have failed. Catherine Blake explains how she and her fellow medics lost the faith.
You get all sorts in an A&E; department. I found myself treating an elderly relative of a New Labour politician: a delightful lady, bright as a button. She’d fallen and hit her head. As usual, there was a battle with the management. A suited young woman insisted that the patient be moved to a ward, so she would not breach the Government target – the one that promises that no patient will spend more than four hours in A&E.; I said she should stay, as I had not finished assessing her. I wasn’t happy for her to go until we knew whether she has a blood clot in her brain. I was told that it was not my decision, and that the bed manager would move the patient.
I explained the situation to the politician, sitting worriedly by her bed, who immediately agreed that she stay in A&E; with me. Whatever the doctor thinks, he said. Suddenly, statistics were not quite so important.
Most doctors voted Labour in 1997. In 2001, Labour again led. But research by Hospital Doctor magazine in association with the online researchers Medix shows that the percentage intending to do so again has more than halved, and Labour now has the support of just 13 per cent of medics in the NHS. It has been reported that, of the 59 senior consultants and GPs who publicly backed Labour in 1997, more than two-thirds have turned their backs on the party.
But why? How can a government that doubled investment in the NHS have lost the support of so much of the medical profession?
Arriving at A&E; for my shift in frosty darkness just before Christmas, I was confronted by a police cordon. I walked around the crime scene – a car, doors open, pool of blood on the road – and into the department.
Surreally, a blood-drenched running shoe lay on the floor.
In the resuscitation room, doors guarded by armed police, were two men who’d been shot. I was assigned to the more stable one: he’d been shot in the face. I spent an hour suctioning blood from what remained of his mouth and fishing out pieces of tooth and flesh. I talked to him and kept his blanket around his shoulders while people bustled around us getting medicines and taking X-rays. He could only nod and shake his head.
This is why I became a doctor: to treat people who desperately need it; to enable them to live when they might have died; to improve the quality of the life they have left. And I became a doctor in the NHS because I believe that survival should not be means-tested. Judging by the circumstances, my patient would not be included in the politicians’ target-voter group of “hard-working families” for whom policy is being tailored.
By 5.30am, I had seen a further 12 people, none of whom were unwell enough to be admitted, and I felt like death. I was talking to Alice, the night receptionist. They’re still booking in, she said wearily. “Nothing bloody wrong with them. You can tell because they are complaining so loudly.”
That night, she was having to ask patients to fill in a glossy questionnaire about why they had chosen to attend this A&E; department. Was it our good reputation? The new foundation status? The nice buildings?
The range of tick-box answers didn’t include: “Because I was in pain,” or: “Because it is near my house,” and certainly not: “Because I was shot in the face.”
Doctors despair because this government is interested in how things appear, rather than how they actually are. Patients don’t matter in this election, which will be fought on clinically meaningless statistics.
So 95 per cent of people in A&E; were seen within four hours? Good: but we know it means that people who ought to have been sent home with painkillers are filling the wards, while waiting-list operations are cancelled again and again because there are no beds. It means that patients who are critically unwell in hospitals are neglected because the junior doctors are kept seeing patients in casualty by all- powerful managers.
Doctors I know are concerned about the accelerated privatisation of the NHS by sub- contracting out vital support and laboratory services, because this compromises care. They are enraged by the proliferation of managers, because managers usually have no understanding of clinical priorities, and their protocols waste precious doctors’ time.
Last year, when I was working in one of the Government’s new flagship Private Finance Initiative hospitals, John, a construction-worker under my care, sat up in bed and vomited two pints of blood, soaking his sheets. He was terrified. I ran to get two large drips, pulled a tourniquet round his arm and tapped his veins.
Having started the fluid running into his veins (to keep his blood pressure up while we cross-matched emergency blood for transfusion), I sent my blood samples to the lab in the metal chute.
Fifteen minutes later, the lab had not received the samples: “It must be lost, send us another one.” I took blood again: he was tachycardic, and his blood pressure was only 90/38.
I sent the blood to the lab again. Still no results. “Can’t you look for them?” I asked, nearing the end of my tether. “It’s not our responsibility if the samples don’t arrive: the chute system is owned by a different company,” the technician said, sounding bored and matter-of-fact on the other end of the phone.
John had hepatitis, a serious, easily transmissable blood-borne disease. When I punctured his vein for the third time and was rushing to put the blood into bottles, I stabbed myself with the needle. Then I ran with the samples myself to the lab, nearly a quarter-mile away, and stood while they analysed them and cross- matched the blood he needed to live until the morning.
It has never been truer than in the increasingly fragmented health service, where everything is someone else’s problem, that if you need something done, you have to do it yourself.
So it’s not surprising that, despite pay rises and the (theoretical) introduction of the working time directive for juniors, 80 per cent of respondents in the Hospital Doctor survey felt there had been no overall improvement for doctors working in the NHS. We had hoped that the election of Labour in 1997 would stop the rot. We were wrong.
While the Government pours money into the health service, and trumpets the fact, we know that the money is being diverted away from care and into the pockets of construction firms.
While we wait for the building of new over-budget, overdue PFI hospitals, there is such disgraceful underfunding in public hospitals that doctors spend hours finding X-rays and notes, and portering patients around because there are fewer and fewer support staff.
People who want to hide the truth from you codify their language and resort to euphemism. This is true in medicine, as in politics. The euphemistic: “You’ve got a shadow on your chest X-ray and we’ll need to do a few tests,” doesn’t quite convey the message.When Tony Blair and the Health Secretary John Reid talk of choice, they mean privatisation. They mean a health service run for profit by global corporations. The threat is real.
A vote for New Labour will mean the end of universal healthcare in this country, and specifically, of free healthcare for the poor.
If you don’t understand what your doctor is saying, you may not take the medicines he prescribes. If you don’t understand what your politicians are saying to you, soon you may not get your hands on any medicines at all. Have a nice day.

The author is a junior doctor in an inner-city NHS hospital. Catherine Blake is a pseudonym
http://news.independent.co.uk/uk/health_medical/story.jsp?story=630792

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Michael Barber ” Mr Targets” is Bliar’s inside man

Dr Search- Principal Consultant at the Search Clinic — Tue, 19 Apr 2005 11:33:00 +0000

Michael Barber- Bliar’s man who bypasses the Department of Health is known throughout Whitehall as “Mr Targets”. Michael Barber, has become one of the key behind-the-scenes figures of Tony Blair’s second term.

As head of the Prime Minister’s all-powerful delivery unit, the 49-year-old former teacher and professor of education can be the bane of ministers’ lives as he runs the rule over their performance.

He is only following his boss’s orders. Mr Barber often forms the warm-up act for Mr Blair’s monthly news conferences. His Powerpoint presentations on different areas of the public services are notoriously dull – but they certainly illustrate his mastery of his brief. What has been much less widely known up to now, however, is the direct role he has played in imposing target culture on individual NHS trusts, seemingly bypassing the Department of Health.

A keen Liverpool fan, Mr Barber was poached by Mr Blair from the Department for Education and Skills, where he was head of its standards and effectiveness unit and devised the current literacy and numeracy targets for schools.

His proudest moment came when target culture featured in EastEnders last year. The character Ian Beale claimed that “people spend at least five hours in A &E;,” only for his partner Jane to reply: “It’s a lot better nowadays.” The exchange was brought up in a Cabinet meeting that week, with one of those present claiming: “That’s worth more than 10 ministerial speeches.”

http://news.telegraph.co.uk/news/main.jhtml?xml=/news/2005/04/10/nhs410.xml

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Billions of pounds of health lies

Dr Search- Principal Consultant at the Search Clinic — Mon, 18 Apr 2005 08:47:00 +0000

The documents given to The Telegraph establish beyond reasonable doubt what all doctors working in British hospitals have long known but many have been afraid to say: that decisions affecting the treatment of patients are being made not on proper clinical grounds but merely to meet government targets that were themselves devised, and are now being used, to make crude party political propaganda.
This is not a marginal problem, and therefore unimportant: it goes to the very heart of the way our hospitals work. The moral and intellectual corruption wrought by Downing Street is now so deep-seated that it will take years to eradicate it.
Hospitals are complex organisms: they have to treat not only people who come to casualty departments but people with acne, constipation and all the thousand natural shocks that flesh is heir to. They are always delicate balancing acts. To set hospitals simple and arbitrary targets, therefore, such as that the waiting time in casualty should not exceed four hours, is to distort and corrupt their work completely. But if this means that patients have to suffer, so be it: just so long as Mr Blair can get a good soundbite out of it.
The email from Paula Friend, the “Director of Delivery” at the Royal Cornwall Hospitals, is by no means untypical. A very similar email was sent last week by the Chief Executive of the hospital in which I used to work. In her email, Ms Friend implies very strongly that doctors should discharge patients sooner than is wise or kind, not to meet a true medical emergency but a politico-bureaucratic one, namely the missing of a completely arbitrary government target. That this might entail discomfort or even danger for the patients hardly seems to matter. The chief executive of my former hospital suggested something very similar in his email, though slightly less baldly.
Several documents make perfectly clear what any student of the Soviet Union would have expected: that in a centrally organised system, the setting of targets results in vast bureaucratic efforts that result in nothing but lies and fraud.
Measures to keep waiting lists down – that is to say, statistical waiting lists, not real waiting lists composed of living, suffering human beings – include asking local general practitioners to delay referral to specialists.
The email from Mr Raphael, ”Director of Finance and Performance” in East Cheshire, is an example. Another way of keeping waiting lists down is not to put patients on such lists until they have replied to a letter from the hospital telling them that they have been referred. Since a substantial number of people reply late, or not at all (some because they are too ill to do so), waiting lists are substantially reduced.
The efforts of the Epsom and St Helier Trust to meet the four-hour target would be comical if they were not nearly criminal. They are worthy of Gogol at his most surreal. At St Helier Hospital on January 24 2005, 13 members of staff, including three doctors, met for an hour in an ”Emergency Access Target Executive Debrief” (does anyone actually think in such language?) At Epsom Hospital, the following day, there was another such meeting, also with 13 people present, of whom three were doctors. If one includes those who apologised for being absent, these meetings involved no fewer than 24 managers. The Department of Health wants such meetings to occur daily, and hospitals managers are now getting updates on how the casualty targets are met every two hours. Thus we see how it is possible to spend billions on the production of lies.
Methods to reduce waiting times in casualty include redesignating trolleys in corridors and elsewhere as hospital beds, shifting gynaecological patients from their ward into an antenatal ward so that casualty patients could be accommodated in the gynaecological ward, renaming observation areas as wards, dumping patients more or less unattended elsewhere in the hospital and, of course, discharging patients in the rest of the hospital too soon – a process I have now witnessed many times myself.
The situation is actually worse than this. The very process of diagnosis is being distorted and corrupted by the targeteering, and risks are being taken by doctors to avoid the admission of their patients to hospital. Not long ago, I saw a patient who had been sent away from a local hospital with completely inadequate treatment, though a medical qualification was not necessary to see that he was seriously ill. It is difficult to believe that such a gross error of medical judgment would have been made without the pressure of having to meet targets; and had he not subsequently been sent to prison, he might have died without proper medical attention.
The managers are both beneficiaries and victims of the whole iniquitous process. They are beneficiaries, because they are paid higher salaries than their talents might otherwise command in any but a corrupt bureaucratic system; but they are victims because they fear for their jobs to such an extent that they are prepared to carry out any order coming from on high. (The fact that, when sacked, they soon find a job elsewhere at a higher salary does not reduce their fear of dismissal.)
As for the doctors, with few exceptions, they also fear to speak out. One of the doctors who wrote an impassioned protest at what was happening asked not to be named, for fear that her outspokenness would result in the sack.
Since doctors are now in receipt of very considerable, and pensionable, bonus payments at the discretion of managers, which can also be withdrawn by the very same managers, they have been corrupted into silence. The evil is now seamless.
The chief executive of an NHS trust not a million miles from where I write this explained the lack of increase in the trust’s budget this year by the lack of marginal seats in the area. The chief executive of another NHS trust, also not a million miles away, said that she spent 80 per cent of her time ensuring that the Labour government was re-elected. She didn’t like it – but then her job depended on it.
With my retirement, I have left these problems behind me. I have achieved what most senior doctors in the NHS wish to do: retire as soon as possible.

http://news.telegraph.co.uk/news/main.jhtml;sessionid=VK2A1M2K1TR0DQFIQMFSM5OAVCBQ0JVC?xml=/news/2005/04/10/nhs310.xml&secureRefresh;=true&_requestid=8107

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Hospitals are bankrupt

Dr Search- Principal Consultant at the Search Clinic — Sat, 16 Apr 2005 09:45:00 +0000

Auditors sound alarm bells in Surrey and Sussex cash crisis- the government must hand over millions of pounds to crisis-stricken Surrey and Sussex Healthcare trust to prevent effective bankruptcy, according to its auditors PricewaterhouseCoopers.
The auditors have told the Department of Health that unless the trust receives ‘substantial further financial support’- via the DoH and Surrey and Sussex strategic health authority- it will fail to meet its statutory duty to balance the books at the end of its three- year break- even period in March 2006.
The zero- starred trust is over £30m in the red after its spectacular failure to deliver on its financial recovery plan for 2004-05. PwC describes its cash position as ‘extremely serious’ and warns that ‘considering the scale of the financial challenge we do not believe that the trust is capable of achieving break-even by the end of 2005-06 without substantial further financial support.’
The report adds that ‘if the trust was to meet all of its obligations up to 31 March 2005 without further support it would have a cash deficit of £36m’.
The auditors’ comments were made as part of its public interest report on the trust. Its decision to make the report – which is sent to the health secretary and the SHA as well as the trust board – is a rare step which auditors would only take in dire financial circumstances.
The report reveals that in January the trust board considered delaying staff salary payments to April and withholding ‘major sums’ owed to the government in the form of pay-as-you-earn, national insurance and superannuation contributions in order to shave off £7.2m from the debt.
The drastic measures were only avoided through a last-minute deal with local primary care trusts, who provided a loan of £4m, and another loan for an undisclosed amount from the SHA.
PwC lists a catalogue of serious errors made by the trust’s finance department – including failure to include deficit repayments or adjust assumptions on funding for the consultant contract. This led to board reports that showed the trust had millions of pounds more at its disposal than it actually had in the bank.
The report said the credibility of the trust’s financial team and its board as a whole has been damaged, and echoes the recommendations of an earlier independent report commissioned by the SHA by calling for an overhaul of the trust’s financial governance. Both chief executive Ken Cunningham and chair Aidan Brown left in February.
Financial troubleshooters Quo Health were sent in by the SHA in February and the company’s co-director, Anthony McKeever, is running the trust as acting chief executive.
Mr McKeever told HSJ that he is ‘consulting with colleagues on a full financial recovery plan’ for 2005-06, which will be presented to the board in May.
He added that he has submitted interim budgets to each department in the meantime, allowing staff to ‘focus on working within the realities of the money they’ve got.’
He said that the trust was recruiting to three senior financial positions to ensure the trust’s financial governance is quickly improved.
‘I need to get in a set of firm figures that tell me the full scale of the out-turn deficit, and I need firm figures relating to this year’s local delivery plan, including the commissioning intention of all the PCTs we work for before I can then take stock of the trust’s position and put in measures to improve it’ Mr McKeever said. He expects proposals to improve the trust’s financial position to be drawn up by the end of the month.
He added that the trust had ‘no realistic prospect of breaking even’ without additional support by next year, and would be looking to other parts of the health economy to work with the trust on identifying a fix. He said this could include ‘selling off property, non-recurrent support or a loan’. He declined to reveal how his proposals would impact on frontline services.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2217967

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Trust given foundation status despite £3m debt

Dr Search- Principal Consultant at the Search Clinic — Fri, 15 Apr 2005 09:30:00 +0000

Lancashire Teaching Hospitals trust was given foundation status this month despite debts of £3m. The trust was awarded foundation status on 1 April, along with five other trusts, even though it is in the red.
The other five in the most recent group to win foundation status were all financially balanced or in credit by the end of the financial year.

Lancashire Teaching Hospitals is the first trust to be authorised as a foundation trust by independent regulator Monitor despite having a significant debt. The move could add weight to critics’ arguments that the policy will create a two-tier system.

Non-foundation trusts have to ensure they meet financial balance in order to win three-star status from the Healthcare Commission – to date, three-star status has been a condition of application for foundation status.

Lancashire Teaching Hospitals was given three stars before it went into the red. However, being in debt does not automatically bar trusts from being granted foundation status if they can demonstrate they are ‘financially viable and sustainable’, a Monitor spokesman said.

He added that Lancashire Teaching Hospitals trust management had submitted a business plan for the next five years demonstrating ‘that they have plans in place to tackle the deficit’.

‘Foundation trusts can incur a deficit and they need to have flexibility in their planning,’ he said.

Lancashire Teaching Hospitals foundation trust finance director Beverly Peacock admitted the trust had financial problems. These included implementing the consultant contract and the provision of tertiary services for cancer, orthopaedics, renal services and plastics.

‘These services were not fully recognised under the non-foundation trust regime but payment by results will address this,’ Ms Peacock said.

Liberal Democrat health spokesman Paul Burstow said: ‘This demonstrates just how absurd the government’s foundation trust policy is.’

He added: ‘It is right that hospitals go through a rigorous process of assessing their financial status but there should be a level playing field so that hospitals are judged on the same standards.’

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2217972

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Docs- Bliar is worst nightmare

Dr Search- Principal Consultant at the Search Clinic — Thu, 14 Apr 2005 08:41:00 +0000

Doctors ‘never dreamt Labour could do this much damage’. Many who backed the party say that increased management is damaging the health service.
When 59 of the country’s leading doctors urged the public to back Labour to save the NHS, it was one of the most powerful clarion calls Tony Blair could have asked for.
The list included a former chairman of the British Medical Association, former presidents and vice-presidents of several royal colleges, medical school deans and numerous emeritus professors and leaders in research. Their specialties stretched to all corners of the profession, from epidemiology, public health, paediatrics and orthopaedics to surgery, sexual infections, renal medicine and general practice.
Eight years on, and many of the same doctors talk not of a health service rescued, but of a Government that has pursued policies as damaging to the fundamental tenets of the health service as the Tory initiatives they so feared.
Many said that, although the number of doctors and nurses may have increased, the power now wielded by managers, who have doubled in number to more than 37,000 since 1997, was turning the NHS into a service that values accountancy over patient care.
Increased use of the private sector for healthcare and building hospitals has also raised the hackles of the medical establishment, and the introduction of competition between institutions is viewed as one of Labour’s biggest betrayals.
The alarm among signatories of the 1997 letter was already evident in 2003, when Vincent Marks, the former dean of medicine at the University of Surrey, was moved to seek the views of his colleagues about plans for foundation hospitals and treatment centres.
Of the 35 who replied to his concerns about the divisive impact of the policies, all but two said they shared his disapproval.
Nigel Speight, a consultant paediatrician based in Durham, told The Times that he and several colleagues had considered writing to the Prime Minister about the creeping privatisation of the NHS.
After 24 years as a Labour Party member, Dr Speight resigned two years ago because of the Iraq war and the Government’s “broken promises” on health. “I never dreamt that a supposedly Labour Government could do so much damage to the fabric and principles of the NHS, which they initially created,” he said.
Chaand Nagpaul, a GP from Stanmore in northwest London, said that, although some improvements were evident, the means by which Labour had achieved them had undermined the profession’s trust in the party as guardian of the health service.
He added: “Labour has undoubtedly made some progress, but there are policies that will fragment the NHS exactly the same way that the Tories did. Many doctors now feel disappointed and surprised. The administration has let down the goodwill of a great number of us.”
Although some doctors said that the extra government funding had achieved little, a minority praised a rise in standards and found little to criticise in Labour’s approach.
Aneez Esmail, Professor of General Practice at the University of Manchester, said that the NHS had undergone a big transformation and that critics should not forget its parlous state in 1997.

http://www.timesonline.co.uk/article/0,,19809-1567070,00.html

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NHS needs fundamental reform not more money

Dr Search- Principal Consultant at the Search Clinic — Wed, 13 Apr 2005 09:28:00 +0000

Here we are again with another election looming and the NHS in the centre of the fray. Only this time, the debate isn’t about whether the NHS needs more cash. Spending has increased by 40 per cent in real terms in just five years and all the major political parties are pledged to spend much more.
The question now is different. Has this money transformed the NHS, as Mr Blair boldly promised it would after the 1997 election? While there might have been improvements, they are at the margins and we are still nowhere near to having the kind of healthcare our European peers enjoy.
Waiting lists have been reduced since the explosion in spending but the average waiting time has remained stagnant and under some measures increased.
Have treatment outcomes improved? This is notoriously difficult to assess, but the international evidence shows we still perform poorly. Survival rates after cancer are amongst the worst in Europe with only the Eastern European countries performing worse. In a recent study examining mortality amenable to healthcare the UK was ranked 18 out of 19 European countries.
Many argue that the beauty of the NHS is that it provides access to care to everyone no matter their status or wealth. This is nonsense. The quality of service all too often depends on being articulate, having an intimate knowledge of the NHS or where you happen to live. This inequity discriminates against the elderly, the less well educated and the less well off.
Before suggesting that the answer is to continue pumping more money into the system, we should consider the Scottish example. NHS Scotland spends £200 more per head than England, but greater resources have not improved outcomes; waiting lists and waiting times have both increased. No-one would seriously hold up the Scottish NHS as a model for healthcare delivery.
What the NHS needs is structural reform. The only way to guarantee equity, universal access and remove politicians from controlling the minutiae of care is to give power directly to the patients. We should fund patients, either through the tax system or by way of universal insurance, to purchase healthcare from the provider of their choice. The poor and unemployed would have their contributions supplemented or paid for by the state.
Patient power would allow resources to be directed to those units providing quality and capacity. Competition would drive up standards. I believe that health professionals have as much to gain as patients from reforms which restore the doctor-patient relationship and eliminate the bureaucracy which is bedevilling our working lives. At last clinical priorities rather than political targets will govern the way we work.

This is the approach favoured by Doctors for Reform, the non-party independent group of nearly 1,000 NHS doctors of which I am a member. We do not advocate a single model of healthcare as each has its drawbacks, but it is clear that Continental systems of social insurance provide minimal waiting lists and quality outcomes. Politicians take the role of guarantor of care and occasional regulator. We should debate these alternatives maturely. It will need a lead from those of us in the NHS to show that real change is in the interests of professionals and patients alike.

Christoph Lees
Founding Member, Doctors for Reform
And NHS Consultant

http://www.doctorsforreform.com/page.asp?pid=80

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MRSA in Great Ormond Street hospital

Dr Search- Principal Consultant at the Search Clinic — Tue, 12 Apr 2005 12:41:00 +0000

Four children aged three or under have died after suffering MRSA infections at Britain’s most famous children’s hospital, figures released under the Freedom of Information Act reveal.
They were among 20 infants whose bloodstream contained MRSA, the most dangerous form of the superbug infection, at Great Ormond Street hospital, London, in the past five years. While 16 of these toddlers recovered, four died and the infection definitely contributed to the death of at least one of them.
The infant, whose precise age was not disclosed, died in 2003 after being infected with MRSA at another hospital and moved to Great Ormond Street.
The figures also reveal that 357 children aged three and under have been found with MRSA at the hospital in the past five years. Most of these would have been less risky forms of infection found in the nose, saliva or an open wound.
Public relations managers at Great Ormond Street originally told The Sunday Times that only seven children aged three and under had been found to be infected with MRSA in the past three years. But, in response to an official request under under the new Freedom of Information Act, the hospital disclosed the full figures.
There has been mounting concern that MRSA has penetrated neonatal units and maternity wards. Last December 14- week-old Connor Bull became one of the youngest known MRSA victims when he caught the infection at Leeds General Infirmary. Claire Wilkinson, his mother, had to scrub down before she could touch him. He managed to fight off the infection after 19 weeks in intensive care.
As MRSA — methicillin-resistant staphylococcus aureus — has become an election issue, hospitals have come under increasing pressure to keep details of infections and deaths secret.
Leeds Teaching Hospitals NHS Trust last week claimed it could not reveal how many babies had been infected or died from MRSA at its hospitals due to government guidance about the disclosure of sensitive information in the build-up to the election.
The Department of Health is also understood to have complained to the Patients Association that the publication of its survey in February showing high rates of MRSA infections in newborn babies overshadowed the government’s NHS Think Clean Day.
The Conservatives have made the fight against hospital-acquired infection a central election pledge. Last week they promised £52m to fight MRSA in hospitals. Michael Howard, the Tory leader, said his party would put matrons back in charge of hospitals and give them the power to shut infected wards.
Tony Blair has called on the public to put the threat of MRSA “in context”. Labour also insists there is evidence that MRSA rates are beginning to fall.
Information obtained under the act also shows that a two-year-old baby infected with MRSA at Bristol Royal hospital for children in June 2003 died. The hospital could not say whether MRSA contributed to the death because the child did not die in the hospital.
Statistics obtained from Alder Hey children’s hospital in Liverpool show that 80 toddlers aged three and under have caught MRSA there, many on neonatal wards, in the past three years.
The figures also reveal that increasing numbers of toddlers are being infected. Seven toddlers caught MRSA at Alder Hey in 2002-3; this rose to 28 in 2003-4 and 45 in the past year.
Last August three-year-old Kian Williams died after picking up MRSA at Alder Hey. He had suffered a “relatively trivial” injury while jumping off steps.
In February a two-day-old baby became the youngest victim to die in hospital from MRSA. Luke Day was born a healthy baby weighing 7lb 7oz but died 36 hours later at Ipswich hospital in Suffolk. Microbiologists say a doctor or nurse was the most likely source.
Professor Hugh Pennington of Aberdeen University, a microbiologist and expert in hospital-acquired infection, said: “This confirms that MRSA is now a problem that affects babies and young children and not just older people and patients who have had a lot of surgery. If we want to tackle MRSA it is a prerequisite that we have accurate information about the scale of the problem.”
This week the actress Leslie Ash, who almost died after becoming infected with a hospital superbug similar to MRSA, will speak about her ordeal at a Patients Association conference about the dangers of dirty hospitals.

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Proof Bliar puts targets before patients

Dr Search- Principal Consultant at the Search Clinic — Mon, 11 Apr 2005 16:29:00 +0000

An investigation by The Telegraph today lays bare how the health of hospital patients up and down the country is put at risk by direct Downing Street interference in the NHS and Labour’s obsession with targets.
Emails and internal NHS documents illustrate how Accident & Emergency patients are pushed aside and placed in danger so that hospitals can meet No 10′s diktats on waiting times.
One doctor described this intervention as “dangerous and intolerable”. She added: “It is only a matter of time before someone dies.”
Another deplored the decision to move patients out of an emergency department because of a losing battle to treat patients within the Government’s target time of four hours. “This constitutes a serious clinical risk,” he said.
The investigation leads directly to Tony Blair’s most senior advisers inside No 10. It shows how Michael Barber, the head of the Downing Street Delivery Unit, has taken charge of enforcing the four-hour waiting time target for casualty departments. At present hospitals must deal with 98 per cent of emergency patients within that time.
Hospitals struggling to meet the target, including the Epsom and St Helier NHS Trust, are forced to make lengthy and detailed “presentations” to Mr Barber and his Whitehall unit on what they are doing to achieve the goal. This was confirmed by documents obtained under the Freedom of Information Act.
Last night Michael Howard, the Conservative leader, called The Telegraph’s findings “an absolutely disgraceful state of affairs” and said he would write to the Prime Minister to demand an explanation. “It is now clearer than ever that Mr Blair’s government is putting targets before patient welfare.
“It’s vital that doctors and nurses are left free to take decisions that are in the interests of patients and not help Mr Blair spin the statistics in his next press releases.”
Chris Grayling, the Tory health spokesman, said: “The Government has, quite literally, created a climate of fear in many parts of the health service. I had one nurse come to see me to tell me that infection control guidelines were being ignored because of the pressure to meet targets. She was too scared, initially, even to give me her name.”
An ICM opinion poll for The Sunday Telegraph today shows that 55 per cent of voters believe that Labour has broken its promises on the NHS, while only 39 per cent believe promises have been kept.
The NHS retains its position at the head of the list when respondents are asked which is the most important election issue. Labour has marginally increased its lead over the Conservatives since last week. It climbed one point to 38 per cent, four points ahead of the Tories, who are unchanged on 34 per cent. The Liberal Democrats are down one per cent on 20 per cent.
The most striking first-hand testimony in The Telegraph’s investigation comes in an email from a young female registrar who has just completed a stint at an NHS hospital in the North West. Her identity is known but is not being disclosed.
She wrote: “I am increasingly dismayed and terrified by current political targets. . . I am worried because the four-hour A & E wait is used as a way to maintain and increase funding. This is affecting patient safety, especially in some trusts.
“I have just finished working in ********* Hospital and the situation there is dangerous and intolerable. A & E will not breach the four-hour targets under any circumstances – when a patient gets to three hours they must be moved to hit the target.”
The email continued: “The wait for a bed is then often more than four hours. A & E remains empty. They cannot be cared for safely and it is only a matter of time before someone dies.”
An email from Dr Rod Storring, a consultant physician at King George Hospital, in Goodmayes, in Essex, records that patients there were “at risk” because of the drive to meet targets. He was told “we would have to continue to do what we are doing until the election, regardless.”
Last night Rosie Winterton, the health minister responsible for A & E treatment, said: “Far from putting lives at risk rapid access to high-quality treatment is saving lives.”
A Downing Street spokesman said: “Our message was and is that we congratulate the NHS on the great improvement in the A & E service. It is a remarkable achievement.”

http://www.telegraph.co.uk/news/main.jhtml?xml=/news/2005/04/10/nhs10.xml

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Why politics and MRSA don’t mix

Dr Search- Principal Consultant at the Search Clinic — Sat, 09 Apr 2005 09:52:00 +0000

MRSA is having a detrimental effect on the UK health economy and our ability to adequately treat hospital-acquired infections. But the desire to combat it with adequately financed and resourced strategies doesn’t exist and the transmissible strains that are driving the epidemic go largely unchecked.
The Department of Health wants to reduce the MRSA blood infection rate by 50 per cent by 2008. The government’s drive to reduce its impact includes a number of proven measures. Those that interrupt transmission, such as frequent hand-washing by healthcare workers, can significantly contribute to this target.
But hand-washing and improving environmental cleanliness cannot and will not cut in half the existing number of blood infections. Other factors in the overall approach highlight a real failure to tackle the threat radically.
Most hospitals provide alcohol-based washes and staff using them 30-40 times a day after treating patients creates new problems. Hands dry out, become chapped and more amenable to the spread of infection. The policy makes it difficult for health professionals to do their job. There are no current easy solutions to this complex problem.
At the start of the global pandemic in the early 1990s, Dutch hospitals introduced a zero-tolerance policy toward MRSA. All elective surgery cases were swabbed and isolated until their status was known. Levels have stayed low ever since.
But MRSA was already rare in this period. Isolate every new UK hospital admission now and you’d have to increase national capacity by around 30 per cent. It isn’t going to happen. Bed-management practices can’t even cope with isolating inpatients with transmissible strains and nobody will commit more money.
Infection control can’t offer all the answers. There is always an element of chance. Specialisation has increased the volume of inter-hospital transfers and it probably only takes one MRSA colonised emergency referral for the best current infection control systems to be beaten.
Moreover, this is hypothetical. Nobody is certain how MRSA gets into hospitals. Government research funding of £3m was announced in 2003 but this has yet to be spent – does this sound like a health service priority? New strains of MRSA are emerging now with increased resistance and virulence and we may run out of suitable antibiotics in the near future. We desperately need to find out how and why MRSA spreads to prevent this happening.
The mandatory surveillance mechanism demonstrates another failing. Trusts only report numbers of MRSA blood infection. But results from blood isolates are just the tip of the iceberg. MRSA infects many other tissue types and causes dangerous and costly conditions such as abscesses, bone infections and pneumonia.
Furthermore surveillance requires little government spending as MRSA bacteraemia figures are collected locally anyway. Such figures give an indication of how much bacteraemia there is but the true burden of MRSA disease, even the number of MRSA attributable deaths, is unknown. People discharged with undetected healthcare-acquired MRSA, in a boil, for example, are readmitted and the MRSA is not considered a healthcare-acquired infection – and therefore doesn’t count in DoH figures.
A simple abscess infected with MRSA can put weeks on an inpatient episode. Cost implications are enormous but if it’s not reported can we ever consider prevention strategies?
Preventive medicine and research in this area aren’t politically attractive. More political capital can be gained from promises like halving MRSA isolation rates in four years than by announcing serious investment in healthcare systems and research to tackle this scourge of modern medicine.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2143860

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Hospitals breaking financial rules

Dr Search- Principal Consultant at the Search Clinic — Fri, 08 Apr 2005 09:25:00 +0000

Monitor has warned hospital trusts that a breach of one of 10 tough new financial rules could provoke intervention. Under the independent regulator’s compliance framework foundation trusts will receive three scores: ‘traffic light’ ratings on governance and the provision of mandatory services; and a score from one to five on financial strength.
A red traffic light score will provoke intervention under the powers given by the Health and Social Care Act 2003, as will a rating of one for financial strength.
The compliance framework sets out the 10 rules Monitor will use to inform the financial score. The rules cover areas including completing correct annual financial plans on time, full repayment of the government’s public dividend capital, and Monitor’s prudential borrowing code for the trust. Breaking some of the rules incur greater penalties than others.
Monitor will also intervene in the running of the trust if it fails to meet any of the government’s national performance targets, including the four-hour maximum wait for patients in accident and emergency.
The Healthcare Commission has agreed to use Monitor’s financial assessment of foundations rather than carry out a separate evaluation.
Foundation Trust Network director Sue Slipman welcomed the framework. ‘We are pleased Monitor has made clear its commitment to ensuring that any regulatory intervention is proportionate to the risks involved, with the most successful trusts having less regulatory oversight.’
Acutes’ foundation plans founder on finances- acute trusts are finding the assessment process for foundation status demanding and struggling with the financial disciplines needed, Monitor said as it rejected two more applicants.
A Monitor spokesman said assessing applicants’ financial viability and sustainability ‘has proved challenging for a number of applicants’.
Six trusts were given foundation status last week: Frimley Park Hospitals; Birmingham Heartlands and Solihull; Lancashire Teaching Hospitals; Liverpool Women’s Hospital; Royal Bournemouth and Christchurch Hospitals; and the Royal National Hospital for Rheumatic Diseases.
But Monitor refused the applications for West Suffolk Hospitals and Wrightington, Wigan and Leigh. Three decisions were deferred: Aintree Hospitals; East Somerset; and Newcastle upon Tyne Hospitals. Altogether, 13 of the 43 aspirant foundation trusts have now had their applications refused, deferred or have chosen to voluntary withdraw.
Monitor said underlying trust deficits had been a problem. The Department of Health wants all trusts to be foundations by 2008.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2180076

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GPs practices to get Tory protection

Dr Search- Principal Consultant at the Search Clinic — Thu, 07 Apr 2005 09:47:00 +0000

The Conservative Party is to campaign against Labour’s plan for ‘super-surgeries’. The Conservatives are to open a campaign to ensure that family doctors running small practices are not forced out of the National Health Service by government reforms, pledging a multimillion-pound package of funding.
Michael Howard is today to announce a major policy initiative to protect small community practices after this week’s reports in The Times of the threat posed by Labour plans for large “super-surgeries” throughout the country.
The Tories will pledge to make funding directly available to GPs to relieve the financial pressures on small surgeries, many of which are being forced to merge into much larger practices under Labour reforms. A “Save our GPs” petition is be sent to every constituency.
Doctors’ leaders this week gave warning that the current government policy would spell the end of the personal relationship between GPs and their patients so critical to people’s long-term care.
Labour plans, outlined by a policy adviser last month, suggest GPs being grouped together in practices of ten or more doctors, with an average of six surgeries per primary care trust. Other work would be carried out by the growing network of walk-in centres and specialist units. There are 31,500 GPs in England and Wales, based at 8,500 surgeries; this could drop to as few as 1,800 surgeries under the plans.
John Reid, the Health Secretary, insisted this week that the Government was pursuing policies that would result in “more GPs than ever before and more GP practices than ever before”. The Prime Minister emphasised that he was “not trying to get rid of basic family doctors”.
But the latest statistics indicate that the number of singlehanded GP practices in England fell by more than a quarter in 2004, with 600 closing or merging with larger practices. The drop — from 2,578 to 1,918 — was more than that in the entire previous decade.
Last year the total number of practices fell by 291 to 8,542 — the largest drop on record.
Doctors fear that a system based on larger practices will destroy the strong relationships built up between GPs and their communities and leave those in more remote areas with poorer access to care.
Health leaders admitted to The Times this week that some primary care trusts had unspoken policies to promote larger, more cost-effective group surgeries, such as providing better building refurbishments. Supporters of supersurgeries say that they will improve care by pooling medical expertise and make it easier to monitor GPs.
Andrew Lansley, the Shadow Health Secretary, said that the Tories would rescue the local, family-based GP with pledges to give doctors power over commissioning care and budgets. An additional £45 million per year will be used to improve out-of-hours care and allow GPs to hold Saturday-morning surgeries. “Labour’s plans to scrap small GP practices and undermine the role of GPs in managing their patient list have been exposed,” Mr Lansley said. “People have a clear choice: faceless super-surgeries which are only open during working hours under Mr Blair or the trusted local GP service with the Conservatives.”
Michael Taylor, of the Small Practices Association, welcomed the funding pledge and said that super-surgeries would create a depersonalised “factory line” of health care.

http://www.timesonline.co.uk/article/0,,2-1551132,00.html

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Sex health crisis swamps clinics

Dr Search- Principal Consultant at the Search Clinic — Wed, 06 Apr 2005 15:28:00 +0000

The true scale of Britain’s sexual health crisis is revealed today in a report showing that two-thirds of clinics are turning away patients because they cannot cope with demand for treatment.
The study, by sexual health charity the Terrence Higgins Trust, warns that clinics in England and Wales are ‘undergoing huge strain’, and predicts a further rise in sexually transmitted infections unless there is urgent action.
Of the clinicians surveyed, 64 per cent said they had turned away patients in the past year, a statistic that has prompted concerns among public health experts. ‘Despite the government’s commitment to improving sexual health, many primary care trusts and clinicians are still struggling to improve access to diagnostic and treatment services,’ said Lisa Power, the Higgins trust’s head of policy.
The report talks of ‘unacceptably’ longer waiting times. One in five patients is waiting a month for a sexually transmitted infection test, while more than a third wait two weeks or more for an HIV test. More than half of the clinics said their ability to provide services had deteriorated over the last year.
The study warns that the failure of many health trusts to deal with the problem could result in a ‘postcode lottery’ in which some of them end up helping to spread infections further as a result of spiralling waiting lists and refusal to see patients.
The findings follow a study led by University College London of the sexual life-styles of ethnic minority groups in Britain, which found that immigration and international travel could be helping to spread infections.
Researchers found the risk of acquiring HIV and other sexually transmitted diseases was likely to rise in ethnic minority groups because of migration, travel and family ties to the Indian subcontinent, south-east Asia and the Caribbean. One in 13 black men had reported an infection in the past five years. The figure for white men was one in 34 and for Indians and Pakistanis fewer than one in 50.
The trust’s findings could become an election issue. Conservative leader Michael Howard has accused Labour of helping fuel ‘an epidemic’ in infections by neglecting sexual health. He said: ‘We have the worst rates of sexual health since records began.’
Howard’s comments followed a Commons health select committee report blaming the ‘the dire’ state of sexual health services for NHS patients on the government, which has pledged to spend an extra £300 million on them.

http://politics.guardian.co.uk/publicservices/story/0,11032,1451338,00.html

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NHS helpine putting patients’ health at risk

Dr Search- Principal Consultant at the Search Clinic — Tue, 05 Apr 2005 10:23:00 +0000

The emergency health service hotline NHS 24 is in chaos, according to a new report which reveals that it is failing to diagnose illnesses on time and is putting patients’ health at risk. An internal review of the £47m-a-year service reveals that half of the patients who telephone for help are forced to wait up to 13 hours for qualified members of staff to call them back.
The number of “adverse events”, where patients may have been harmed as a result of bad advice, was seven times higher than the service’s target.
The report also reveals that one in five staff members has resigned since the service was launched and sickness rates are double acceptable levels, mostly as a result of stress and nervous disorders.
Last month Jack McConnell, the first minister, announced a review of NHS 24 after it was revealed that thousands of patients every month were kept waiting to speak to a nurse.
Doctors claimed that a quarter of full-time qualified nursing posts were unfilled. Nurses have left to escape weekend and evening shifts which have grown since new legislation allowed GPs to opt out of out-of-hours medical cover.
However the latest report, presented to the agency’s board a fortnight ago, reveals that problems are greater than previously thought.
Last night opposition politicians called on McConnell to take more urgent action to tackle the crisis. “It is clear that the crisis within NHS 24 is deepening and that ever more serious problems are arising,” said Shona Robison, the SNP health spokeswoman. “There are too many complaints coming in and I am worried that people are going to end up seriously ill because they have been left to wait too long.
“Where patients could have been harmed by these adverse events, which would cover misdiagnosis and bad advice, their cases must be investigated to establish what went wrong. The executive must ensure that when people make a call they are not kept waiting for hours and that they get the proper advice. This is a key frontline service and if people lose confidence in it they will just stop using it and turn up at A&E; units instead.”
The inquiry was launched by by John McGuigan, the chief executive of NHS 24, in February. It found that 46% of patients had to wait for a medically trained expert to call them back, three times above what the service classes as an acceptable level and nine times worse than in January last year.
It revealed that between December and February there were 15 significant adverse events. NHS 24’s own target is no more than two events per quarter. In February 53 patients made complaints, compared with five last year.
Sickness levels have reached a record level, with 11% of days now lost to illness, which is double the target. The most common reason given by staff is “nervous disorder” and workload is cited as the big pressure.
“It is hardly surprising that the problems identified in this report are occurring because the workload has increased by a factor of 20 in the past 18 months,” said Jim Devine, the Scottish organiser for Unison. “What was initially set up as a helpline has developed into providing support for the whole health service and for the lack of GP cover at night and weekends.”
Last month it was revealed that a woman who called NHS 24 in severe pain was misdiagnosed as suffering from constipation. She decided to go to Dunbar hospital in Thurso where she underwent an operation for acute appendicitis.
In another case Lucy Gordon, from Aberdeen, said she had to wait 13 hours to speak to an NHS 24 nurse after she reported that her three-year-old son had a high temperature.
In a third case, a man was kept on hold for an hour when he tried to get help for his wife who was vomiting and writhing. She was later diagnosed as having gallstones.
A spokesman for NHS 24 said: “NHS 24 has provided a high quality service to almost 2m callers since its inception. However, we recognise that there are always challenges and improvements which can be made to any organisation.”

http://www.timesonline.co.uk/article/0,,2090-1552914,00.html

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Names of millionaire NHS dentists kept secret

Dr Search- Principal Consultant at the Search Clinic — Mon, 04 Apr 2005 10:21:00 +0000

Labour govt officials are coming under pressure to release the names of dental practices that are earning million-pound incomes in the National Health Service.
Figures released under the Freedom of Information Act by the government’s Dental Practice Board of England and Wales show that 50 practices are being paid close to, or more than, £1m a year. One was paid £2.2m by the taxpayer last year in fees.
The board is refusing to disclose the identities of these practices or even to say how many dentists work in them.
This comes despite a recent decision to publish data on subsidies paid to individual farmers. In addition, the payment of public money to lawyers under legal aid has long been public knowledge as have the salaries of senior public figures.
The dental board claimed this weekend that figures on the NHS earnings of individual dentists was “personal data” and as such was exempt from publication under the act.
The Sunday Times applied twice to the board under the Freedom of Information Act to release the data. As this resulted in only partial publication, the paper has this weekend appealed to Richard Thomas, the information commissioner, to rule on whether the board should release full data.
Simon Williams, chairman of the Patients Association, said the public was entitled to know which dentists had earned most from the taxpayer. “These figures should be published,” he said.
Dentists are pressing the government to increase payments from the health service. They claim that increasing numbers of practitioners are restricting themselves to private practice as it has become too difficult to earn a living working for the NHS, although these claims have not been independently audited.
The refusal by the dental board to release information comes as the government considers rises in charges that could lead to fees for a basic check-up rising from £5.50 to £12, while those for fillings could go up from £18 to £40.
The British Dental Association said: “The fees dentists receive for NHS treatment do not solely cover their salary. From that figure they must also cover practice expenses including their premises, equipment, staff salaries and training.
“They do not receive the same allowances as other professions like GPs to cover practice expenses and this should be borne in mind.”

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FT Editorial- Electronic records

Dr Search- Principal Consultant at the Search Clinic — Fri, 01 Apr 2005 12:45:00 +0000

The biggest failure to date of the National Health Service’s £6.2bn programme – the biggest civil information technology project in the world – has been one of communication.
The programme is intended to provide an electronic patient record and much else – e-booking of appointments, electronic transmission of prescriptions and digital images available in hospitals up and down the land.
The potential benefits are huge – in terms of increased patient safety and convenience, better quality medicine and greater efficiency and flexibility in the way healthcare is delivered.
Repeated surveys have shown that the programme has failed to engage adequately with the doctors, nurses and therapists who will use it. But, worse, it has failed to explain clearly to the most important people of all – the patients – how the system will work and what their rights to confidentiality will be under it.
It is quite incredible that two years into the programme, and within a year of the first records beginning to go live, this issue has yet to be settled.
Patients will have two concerns. First will be security. Here there can be, in practice, no absolute guarantees, as the bitter experience of banks and other businesses that increasingly rely on IT-driven systems shows. Anything and anywhere, even the Pentagon, has proved hackable. And in the NHS as in other businesses, employees may prove bribable or subornable to provide information that should remain private.
That said, what is known about the planned security sounds reassuring. Access to patient records by NHS staff will be on a need-to-know basis. There will be a clear audit trail of who has accessed records and when, and clear penalties for misuse.
The second concern will be over confidentiality. It seems clear from ministerial statements that patients will have a right not to join the system – forgoing the potential benefits in terms of their own treatment and safety that the record can bring. But after that there is confusion.
The programme originally proposed that there should be a “sealed envelope” containing information patients might regard as sensitive – past mental illness, an abortion, sexual history perhaps – that would only be opened in an emergency or with their permission.
But the board that advises ministers on the programme has gone further and suggested that patients should have the further right to withhold information entirely while still having, in all other respects, an electronic record.
But it is unclear whether these proposals will be accepted and, even if they are, precisely how they will work.
A resolution to these issues has been long promised – and is now long overdue. If that does not happen soon – with patients’ rights clearly spelt out – faith in the electronic record could well be seriously undermined and a £6.2bn investment could turn into a £6.2bn fiasco.

Published: April 1 2005 03:00

http://news.ft.com/cms/s/1aa8ef0c-a24b-11d9-8483-00000e2511c8.html

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Political pressure is undermining finance reforms

Dr Search- Principal Consultant at the Search Clinic — Fri, 01 Apr 2005 09:11:00 +0000

Political pressure undermining finance reforms, warns Dredge- political manoeuvring could wreck the government’s flagship NHS finance reform, a chief architect of the policy has broken cover to warn.
Former Department of Health head of financial flows Bob Dredge said political pressure from ‘powerful teaching hospitals’ was behind the government’s decision in June to halt plans for ‘fairer re-distribution’ of training and research and development monies worth £5bn among acute trusts.
Mr Dredge went on to describe the DoH’s decision in December to allow health economies to ‘unbundle the tariff ‘ to reflect local patient flows and to make adjustments to the short-stay tariff as a ‘political fudge’ designed to ‘show the NHS it was being listened to’. And he said that continued unbundling of the tariff undermined the reform and ran the risk of leaving finance systems ‘back where we started’.
Speaking publicly for the first time since leaving his post in December, Mr Dredge outlined his fears that the government could ‘lose its nerve’ and delay PbR for a second time. Full PbR was due to be introduced next month, but in January the government announced its decision to delay total implementation by one year.
Mr Dredge told a Chartered Institute of Public Finance and Accountancy conference: ‘The party line is that PbR will be rolled out for emergency and outpatients next year, but I question if they will hold their nerve now they’ve managed to delay it once fairly easily.’
He said his ‘worry’ is that the DoH now has a few ‘intellectually credible get-out-of-jail-free cards’ that they can deploy if they ‘lose their nerve’ again next year.
Mr Dredge said that fixing the system for full introduction for next year would ‘take a lot of work’ and suggested the DoH might use the risk of a possible imbalance across the NHS as an excuse for further delay as April 2006 approaches.
The DoH halted an April PbR start for emergency and outpatients care at the eleventh hour because of a £500m ‘imbalance’ across the NHS.
Mr Dredge, now a senior fellow in financial management at Keele University’s Health Planning Centre, said he decided to speak out now to inspire informed public debate about the government’s policy direction.
‘PbR was designed to be a “destabaliser” – a policy that would rock the system, which it is starting to do,’ he said. ‘There is nowhere to hide under PbR, and it is challenging. However the question is: can we overcome the influence of certain powerbases and hierarchies to gain the real, evidence based cash benefits?’ he added.
Mr Dredge saved his fiercest fire for the move to allow health economies to unbundle the tariff – which he described as a ‘messy response’ to pressure from parts of the NHS.
‘If you allow a whole load of unbundling – where you pay for little bits of the healthcare resource from up here and there – you destroy the principles, don’t achieve the benefits, and end up with locally based recovery systems, which is back to where we started with this reform. There is a view from parts of the NHS that wants lots of local systems and local rules, which is completely contradictory to a national system. Either you have a system or you don’t.’
Dredge judges: the key dangers
* Emergency payment by results: the risks of imbalance will still be great next year and the government could ‘lose its nerve’. The Department of Health is likely to halt further introduction to mental health and community care, which could lead to one set of rules for powerful foundation trusts and another set for other providers.
* Short-stay tariff adjustments: the DoH’s response to PCT fears that trusts would collect a tariff for a long stay when the patient discharged after two nights is a ‘political fudge’.
* Unbundling the tariff: allowing tariffs to be split locally according to care pathways threatens to undermine the foundations of PbR. Hierarchies forced this ‘messy response’ against the spirit of reform.
* Research and development and training: the government made a U-turn last June on plans to balance £5bn allocations for training and research and development more fairly across the NHS due to ‘pressure from the powerful London teaching hospitals’.
* The market forces factor (MFF): there are too many different zones now that each PCT has been given its own MFF. It is too complex and the system can be simplified.

http://www.hsj.co.uk/nav?page=hsj.news.story&resource;=2089136

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